Enhanced recovery after surgery: Preoperative carbohydrate loading and insulin management in type 2 diabetes.

We assessed our institutional practice of individualized insulin dosing for patients with type 2 diabetes receiving preoperative carbohydrate loading (CHO-L) within an enhanced recovery after surgery (ERAS®) protocol. Patients enrolled in an ERAS® protocol with concomitant type 2 diabetes received rapid acting insulin (Novolog®[insulin aspart]) prior to 50 g CHO-L on the day of surgery. Following CHO-L and the administration of insulin, no hypoglycemic episodes occurred with preoperative POC glucose values between 6.

Correlation of Hemoglobin A1C and Outcomes in Patients Hospitalized With COVID-19.

Objective: Diabetes is a known risk factor for severe coronavirus disease 2019 (COVID-19). We conducted this study to determine if there is a correlation between hemoglobin A1C (HbA1C) level and poor outcomes in hospitalized patients with diabetes and COVID-19.

Methods: This is a retrospective, single-center, observational study of patients with diabetes (defined by an HbA1C level of ≥6.

Efficacy of Hybrid Closed-Loop Insulin Delivery System in a Hospital Setting: A Case Series.

Objective: We report a case series of 4 patients with type 1 diabetes who used hybrid closed-loop insulin pumps (Medtronic MiniMed 670 G) during hospitalization.

Methods: Clinical data and point-of-care glucose values are presented for each patient. Glucose values are shown graphically while in manual mode as well as in auto mode.

Continuous Subcutaneous Insulin Infusions vs. Multiple Daily Injections of Insulin in Hospitalized Patients: Glycemic Trends in the First 24 Hours of Admission.

Background: Continuous subcutaneous insulin infusion (CSII) is a common diabetes treatment modality. Glycemic outcomes of patients using CSII in the first 24 hours of hospitalization have not been well studied. This timeframe is of particular importance because insulin pump settings are programmed to achieve tight outpatient glycemic targets which could result in hypoglycemia when patients are hospitalized.

SAFETY AND EFFICACY OF GLUCOSTABILIZER IN THE MANAGEMENT OF DIABETIC KETOACIDOSIS.

To evaluate the safety and efficacy of GlucoStabilizer software intravenous insulin (IV) dosing in comparison to American Diabetes Association protocol-directed provider-guided insulin dose adjustment (PGIA). GlucoStabilizer calculates the dose of IV insulin required to reach a prescribed target glucose range. GlucoStabilizer has not been fully studied in DKA.

CHANGING TO BASAL-BOLUS INSULIN THERAPY FOR THE INPATIENT MANAGEMENT OF HYPERGLYCEMIA-A NATURAL EXPERIMENT.

Most acute-care hospitals have transitioned from sliding-scale to basal-bolus insulin therapy to manage hyperglycemia during hospitalization, but there is limited scientific evidence demonstrating better short-term clinical outcomes using the latter approach. The present study sought to determine if using basal-bolus insulin therapy favorably affects these outcomes in noncritical care settings and, if so, whether the magnitude of benefit differs in patients with known versus newly diagnosed type 2 diabetes. This natural experiment compared outcomes in 10,120 non-critically ill adults with type 2 diabetes admitted to an academic teaching hospital before and after hospital-wide implementation of a basal-bolus insulin therapy protocol.

Software-guided insulin dosing improves intrapartum glycemic management in women with diabetes mellitus.

Background: During labor, maintenance of maternal euglycemia is critical to decrease the risk of neonatal hypoglycemia and associated morbidities. When continuous intravenous insulin infusion is needed, standardized insulin dosing charts have been used for titration of insulin to maintain glucose in target range. The GlucoStabilizer software program (Indiana University Health Inc, Indianapolis, IN) is a software-guided insulin dosing system that calculates the dose of intravenous insulin that is needed based on metabolic parameters, target glucose concentration, and an individual's response to insulin.

A new look at established therapies: practical tools for optimizing insulin use.

Purpose: Current evidence shows early initiation of insulin therapy in type 2 diabetes mellitus (T2DM) improves glycemic control, responsiveness to subsequent oral antidiabetic therapies, beta-cell function, and possible cardiovascular outcomes. The American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2008 algorithm introduces insulin therapy earlier in the treatment of T2DM with prompt intensification to achieve therapeutic goals. Agent selection and insulin regimens are based on patient A1C levels and willingness to monitor blood glucose, use of previous medications, blood glucose patterns, diet, and lifestyle.

Translating clinical trial data into new patterns of practice.

Purpose: The ongoing research into the intricacies of glucoregulation and the upsurge in the number of pharmacologic therapies has broadened the treatment options for type 2 diabetes. Successful translation of pharmacologic clinical trial data into new patterns of practice begins by creating the space for a new therapy through a thorough understanding of its mechanism of action.

Conclusion: This article will discuss important considerations for identifying patients who could benefit from incretin mimetic therapy, the role of the diabetes educator in building a cohesive team, and teaching strategies that support patients' self-management efforts.

The insulin resistance syndrome and coronary artery disease.

Insulin resistance is an increasingly common metabolic abnormality characterized by an impaired physiological response to insulin. The constellation of insulin resistance and several other metabolic and vascular disorders is known as the insulin resistance syndrome. The characteristic features of the insulin resistance syndrome include central obesity, hypertension, dyslipidemia, glucose intolerance and specific abnormalities of both endothelial cell and vascular function.